Men, Pornography, and the Desire to Quit

A few months ago I wrote about a recent French study looking at porn use among adult males and its consequences. In that study the research team concluded, among other findings, that men who look at porn to self-soothe and regulate their emotions were significantly more likely to experience porn related consequences and to view their usage as problematic. (Click here to read my earlier article.)

Now we have a relatively similar American study authored by Shane Kraus, Steve Martino, and Marc Potenza (from Bowling Green, Yale, and Yale). This research further examines the clinical characteristics of male porn users, in particular their interest in seeking treatment. The study surveyed 1,298 adult men who’d used porn at least once in the past 6 months. Participants were recruited via three websites—Craigslist.com, Psych-Research.com, and Psych.Hanover.edu. To ensure unbiased results the participants were not paid, though a $2 donation was made to the American Cancer Society for each completed questionnaire. The mean age of the men studied was 34.4, with test subjects hailing from the US (80%), Canada (8%), and various other English speaking countries (11%).

Participants in the study answered questions about:

Demographics—age, relationship status, education, etc.

Sexual History—number of sexual partners, frequency of masturbation, history of STDs, etc.

One in fifteen (6.4%) of the men studied reported previous treatment related to porn use. One in seven (14.3%) reported a current interest in seeking treatment.

More than one in four (28%) of the survey participants scored at or above the suggested Hypersexual Behavior Inventory cutoff, indicating the possibility of sexual addiction. This number almost exactly matches results in the French study, where 27.6% of the men studied either met or exceeded the HBI cutoff.

Note: The numbers in both studies are probably skewed in relation to the general population, as both survey samples were recruited exclusively online, and participation was limited to men who’d recently used pornography.

Of the individuals currently interested in treatment related to porn use, 71% scored at or above the HBI’s sex addiction cutoff, with 29% not meeting that standard. About this latter group, the authors of the study state:

Specifically, it would be important to understand whether additional factors (e.g., relationship status, level of religiosity, and personal values/beliefs) relate to men’s self-reported interest in seeking treatment for use of pornography.

This strikes me as a reasonable interpretation of the findings, very much in accord with anecdotal evidence provided by certified sex addiction treatment specialists (CSATs) who, in a general way, report that a small percentage of clients seeking assistance related to porn use have based their self-assessment of sex/porn addiction on shame and self-loathing rather than on commonly accepted clinical criteria. Moreover, this seems to occur far more often in clients with conservative religious backgrounds—environments where porn and other forms of non-marital sex are often vilified.

Further analysis shows that when compared with treatment disinterested men, the treatment interested population uses porn more often and for longer periods of time, has many more cut back and quit attempts, and scores significantly higher overall on the Hypersexual Behavior Inventory. These findings are unsurprising, and they line up perfectly with the criteria typically used by CSATs to identify and diagnose sex and porn addiction:

Preoccupation to the point of obsession (best evidenced by frequency and duration of use)

Loss of control (typically evidenced by multiple failed attempts to quit or cut back)

Findings regarding failed attempts to cut back or quit altogether are especially enlightening in this study. With treatment disinterested men 34.6% had tried to cut back at least once, and 25.0% had tried to quit at least once. With treatment interested men the numbers were much higher, with 87.1% trying to cut back at least once, and 74.7% trying to quit at least once. Moreover, treatment interested men were 4.1 times as likely to have tried cutting back on four or more occasions, and 6.9 times as likely to have tried quitting on four or more occasions—numbers that indicate the same “loss of control” we see with other types of addiction.

Unfortunately, the new study did not look deeply at motivations for use. If it had, it would likely have confirmed the French study’s finding that attempts to self-soothe and regulate emotions are directly linked to negative consequences—an important result as it provides another significant parallel between sexual addiction and other forms of addiction. (In general, addictions of all types are motivated more by a desire for escape than a desire for pleasure.)

Still, Kraus, Martino, and Potenza have provided yet another link in the chain that will eventually force the hand of the American Psychiatric Association, an organization that has so far chosen to willfully ignore the existence of sexual addiction—this despite an APA commissioned position paper written by Harvard’s Dr. Martin Kafka recommending the inclusion of Hypersexual Disorder, as Kafka prefers to call this issue, in the DSM-5.

For now, CSATs and others who treat sexually addicted clients will continue to diagnose and treat sexually addicted individuals as we have always done, using the generally accepted though unofficial diagnostic criteria outlined above to identify the disorder (erring on the side of caution by under rather than over diagnosing), and then treating the disorder in ways that have proven effective with not only sexual addiction, but other addictions. Most often this involves a combination of inpatient and/or outpatient individual and group therapy that relies heavily on cognitive behavioral and accountability tasks, coupled with social learning and external support (including participation in 12-step groups like SA, SAA, SCA, and SLAA).

About Robert Weiss LCSW, CSAT-S

Robert Weiss LCSW, CSAT-S is a digital-age intimacy and relationships expert specializing in infidelity and addictions—in particular sex, porn, and love addiction. He is the author of several highly regarded books, including “Out of the Doghouse: A Step-by-Step Relationship Saving Guide for Men Caught Cheating,” “Sex Addiction 101,” and “Sex Addiction 101: The Workbook.” Currently, he is Senior Vice President of National Clinical Development for Elements Behavioral Health, creating and overseeing addiction and mental health treatment programs for more than a dozen high-end treatment facilities. For more information please visit his website, robertweissmsw.com, or follow him on Twitter, @RobWeissMSW.